Scalene node biopsy in carcinoma of the cervix. Pelvic and para-aortic lymphadenectomy

Twenty-eight patients with advanced untreated carcinoma of the cervix had selective pelvic and para-aortic lymphadenectomy and a scalene fat pad biopsy to determine the extent of their disease prior to treatment. None of these patients had palpable supraclavicular lymph nodes, but 18 had metastatic cancer in one or more pelvic lymph nodes; in the remaining 10 patients, all lymph nodes were free of metastatic cancer. Of the 18 patients with metastatic cancer in the pelvic lymph nodes, 9 also had metastatic cancer in the para-aortic lymph nodes, and 1 had metastatic cancer in a scalene lymph node. This patient had extensive cervical cancer with positive pelvic and para-aortic lymph nodes, unilateral ureteral obstruction, and cancer growing through the posterior culde-sac into the pelvic peritoneum. From this study, it appears that scalene lymph node biopsies are of limited value in evaluating patients with advanced cancer of the cervix. Unless the patient has extensive metastases, scalene lymph nodes rarely contain metastatic cancer.